Brazilian Journal of Medical and Biological Research (2006) 39: 545-553

Epidemiological studies in the information and genomics era

ISSN 0100-879X

545

Epidemiological studies in the

information and genomics era:
experience of the Clinical Genome
of Cancer Project in So Paulo, Brazil
V. Wnsch-Filho1,
J. Eluf-Neto2,
P.A. Lotufo3,4,
W.A. da Silva Jr.5
and M.A. Zago6

1Departamento

de Epidemiologia, Faculdade de Sade Pblica,

de Medicina Preventiva, 3Departamento de Clnica Mdica,
Faculdade de Medicina, 4Hospital Universitrio, Universidade de So Paulo,
So Paulo, SP, Brasil
5Departamento de Gentica, 6Departamento de Clnica Mdica,
Faculdade de Medicina de Ribeiro Preto, Universidade de So Paulo,
Ribeiro Preto, SP, Brasil
2Departamento

Abstract
Correspondence
V. Wnsch-Filho
Departamento de Epidemiologia
Faculdade de Sade Pblica, USP
Av. Dr. Arnaldo, 715
01246-904 So Paulo, SP
Brasil
E-mail: wunsch@usp.br
Research supported by FAPESP
(No. 01/12897-8) and Ludwig Institute
for Cancer Research.

Received June 17, 2005

Accepted March 2, 2006

Genomics is expanding the horizons of epidemiology, providing a

new dimension for classical epidemiological studies and inspiring the
development of large-scale multicenter studies with the statistical
power necessary for the assessment of gene-gene and gene-environment interactions in cancer etiology and prognosis. This paper describes the methodology of the Clinical Genome of Cancer Project in
So Paulo, Brazil (CGCP), which includes patients with nine types of
tumors and controls. Three major epidemiological designs were used
to reach specific objectives: cross-sectional studies to examine gene
expression, case-control studies to evaluate etiological factors, and
follow-up studies to analyze genetic profiles in prognosis. The clinical
groups included patients data in the electronic database through the
Internet. Two approaches were used for data quality control: continuous data evaluation and data entry consistency. A total of 1749 cases
and 1509 controls were entered into the CGCP database from the first
trimester of 2002 to the end of 2004. Continuous evaluation showed
that, for all tumors taken together, only 0.5% of the general form fields
still included potential inconsistencies by the end of 2004. Regarding
data entry consistency, the highest percentage of errors (11.8%) was
observed for the follow-up form, followed by 6.7% for the clinical
form, 4.0% for the general form, and only 1.1% for the pathology
form. Good data quality is required for their transformation into useful
information for clinical application and for preventive measures. The
use of the Internet for communication among researchers and for data
entry is perhaps the most innovative feature of the CGCP. The
monitoring of patients data guaranteed their quality.

Key words

Multicenter studies
Large-scale studies
Molecular epidemiology
Data control quality
Cancer epidemiological
studies

Braz J Med Biol Res 39(4) 2006

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V. Wnsch-Filho et al.

Introduction
Large-scale epidemiological studies have
been conducted in the past. An example is
the largest human experiment ever executed
- the population-based study that evaluated
the effectiveness of the Salk vaccine in 1954,
involving almost one million children (1).
However, the major risk factors for nontransmissible chronic diseases were identified as the result of epidemiological studies
initiated and carried out by individual investigators belonging to relatively small research
groups. Large-scale projects in the biomedical field are currently being developed, involving a large number of centers and the
interaction of researchers from different fields
of knowledge seeking a common goal. The
first and best known of these endeavors was
the Human Genome Project, an international
consortium integrating scientific institutions
from a number of countries (2). Several
other studies with similar characteristics, such
as the BioBank UK study (3), aimed at obtaining biological samples from 500 thousand individuals aged 45-69 years in order to
study the role of genes and their interaction
with environmental and lifestyle variables in
the occurrence of a number of diseases, are
still ongoing. The organization of such massive projects was made possible by the great
advances in informatics which took place in
the last decades and by the easy communication provided by the world computer network. The exponential dissemination of the
Internet in the 1990s affected the daily routines of millions of people, and an expressive volume of data currently circulates
among the computers of researchers throughout the world.
In cancer research, the demand for largescale studies is due, at least in part, to the
advances in the fields of genetics and molecular biology. Only the availability of a large
number of observations will provide the statistical power necessary for an analysis of
the effects of gene-gene and gene-environBraz J Med Biol Res 39(4) 2006

ment interactions in neoplasm etiology (46).

Three major options for large-scale studies are available: meta-analysis, pooled analysis and multicenter studies with an individual base. In multicenter studies the design and conduct of the investigation and the
collection of data at different centers are
done according to a common study protocol.
One main challenge of multicenter studies is
to maintain the comparability of data in terms
of exposure, outcome and confounder variables. It is also necessary to consider logistic
issues in order to obtain a similar timing
among the different clinical groups. Additionally, great care is necessary during the
joint analysis due to the heterogeneity of
results from different centers.
Practical issues regarding initiating, organizing, managing, and evaluating the studies emerge in the context of multicenter
large-scale projects. The articulation of several research groups located in different regions, the volume of data generated from a
large number of patients, and the manipulation and collection of biological samples
from these subjects require non-conventional
solutions for registration, storage, and quality control operations.
The present paper describes, from an
epidemiological perspective, the methodology developed for the collection and data
quality control in the multicenter study called
The relationship between the differences in
gene expression and the clinical and pathological features of human cancers, or, simply, the Clinical Genome of Cancer Project
(CGCP), a project initiated by FAPESP (So
Paulo State Research Support Foundation)
and financed by this agency and by the
Ludwig Institute for Cancer Research (7).
The CGCP is a large-scale project - possibly
the largest currently being developed in Brazil in the field of oncology - aimed at investigating the profiles of gene expression in
normal and cancerous cells and correlating
these profiles with the etiology and progno-

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Epidemiological studies in the information and genomics era

sis of the tumors under investigation. This

knowledge may be used in the future to
monitor new methods for the diagnosis and
treatment of cancer.
The experience acquired by the epidemiology team while organizing and managing
the CGCP data may be of use to researchers
in the field of health care currently involved,
or who may become involved in the future,
in large-scale multicenter studies.

Material and Methods

The CGCP involves specialists in internal medicine, surgery, pathology, molecular
biology, and epidemiology (participants are
listed at the end of the article). The project is
aimed at consolidating data on a large number of patients with well-defined diagnoses
of nine types of tumors (astrocytoma, head
and neck squamous-cell carcinoma, esophageal squamous-cell carcinoma, gastroesophageal junction cancer, gastric adenocarcinoma, colon and rectum carcinoma, multiple myeloma, osteosarcoma, and acute lymphoblastic leukemia) and at collecting biological samples (blood, tumor tissue, and
normal tissue) from these patients.
Participant groups were selected according to FAPESPs peer-review principles.
Clinical, pathology, and epidemiology groups
answered a call from FAPESP, which defined evaluators from international institutions to select the groups that would participate in the study. Initial meetings were conducted in order to consolidate the plan and
to define a field work strategy. Researchers
maintain contact through the Internet and
occasionally hold specific meetings with their
groups and CGCP holds a biannual meeting
for all members.

the CGCP:
Cross-sectional studies for the analysis
of gene expression. Using micro-array technology, the aim is to compare the prevalence
of gene expression between normal and cancerous tissues. Therefore, when feasible
(head and neck, esophageal, gastroesophageal junction, stomach, colon and rectum
tumors and osteosarcoma), samples of normal tissue adjacent to the tumor are collected. In the case of astrocytomas, the analysis of gene expression will be compared to
non-neoplastic tissue samples obtained from
individuals without a diagnosis of cancer
who were submitted to other neurosurgical
procedures, most of them related to surgical
correction of epilepsy.
Case-control studies for the analysis of
etiological factors. These studies are aimed
at evaluating the risk of disease according to
the prevalence of specific genetic polymorphisms. Thus, DNA was extracted from the
peripheral blood of cases (patients with specific tumors) and controls (patients with diseases other than cancer - except for skin
cancer - which are not related to risk factors
for the tumors under investigation, matched
with cases by sex and age). Potential interactions between polymorphisms and lifestylerelated factors (smoking or alcohol consumption) may be studied.
Follow-up studies for the evaluation of
prognosis. Five-year survival and other outcomes - such as regional and distant metastases, response to treatment, and clinical
evolution of patients with the same type of
cancer - will be investigated in terms of
different combinations of clinical or histological variables and distinct patterns of gene
expression and genetic polymorphisms.
Patient recruitment logistics

Basic designs of the collaborative study

Each clinical group is guided by specific

objectives; however, three common epidemiological study designs can be identified in

The research protocol was approved by

the National Commission of Ethics in Research (CONEP, Braslia, DF, Brazil) and
by the Ethics Committees of all hospitals
Braz J Med Biol Res 39(4) 2006

548

V. Wnsch-Filho et al.

included in the CGCP. The recruitment of

patients for the project began in the first
trimester of 2002 and should continue to the
end of 2005. Cases and controls come from
eighteen clinical facilities in the cities of So
Paulo, Ribeiro Preto, Campinas, So Jos
dos Campos, and Botucatu, merged into
twelve clinical groups linked to the nine
groups of tumors under investigation (Figure 1). The clinical team of each hospital
identifies cases and controls.
Throughout the year 2002, several meetings between the researchers of each clinical
group and the epidemiology group were held
in order to discuss the routines of patient
recruitment, the format and content of the
research forms, the procedures of data regis-

tration, and the transportation and storage of

biological samples.
Five forms were designed to record patient data: a) the general form, containing
information such as age, sex, place of birth,
and previous exposure to lifestyle and environmental risk factors such as smoking and
alcohol consumption; b) the clinical form,
containing clinical and laboratory data; c)
the pathology form; d) the follow-up form,
containing data on the clinical status of the
patient during the follow-up period, and finally e) a specific form for organizing the
data relative to the biological samples.
We developed forms with specific questions for each type of tumor. Control patients
answered the questions in the general form

General
coordination

Epidemiology
group

Bioinformatics
laboratory

Pathology
group

Astrocytoma
group

HC/USP/RP
HC/USP/SP
HSP/UNIFESP

Head and neck

group

Esophagus
group

Cardia
group

Gastric
group

Colorectal
group

Multiple myeloma
group

Osteosarcoma
group

Acute
lymphoblastic
leukemia group

HC/USP/SP

HC/USP/SP

HC/USP/SP

HC/USP/SP

HC/USP/SP

HH

HSA/UNISA

HOC

HOC

HOC

HC/USP/RP

HSA/UNISA

HSL

HC/USP/SP

HSP/UNIFESP

HSP/UNIFESP

IOP/UNIFESP

ICAVC

HC/UNESP

UNIVAP

HSP/UNIFESP

IOP/UNIFESP

CIB

Figure 1. Flow chart of the Clinical Genome of Cancer Project.

Clinical centers:
CIB
HC/UNESP
HC/USP/RP
HC/USP/SP
HH
HOC
HSA/UNISA
HSL
HSP/UNIFESP
ICAVC
IOP/UNIFESP
UNIVAP

Boldrini Child Center/Campinas

University Hospital/State University of So Paulo/Botucatu
University Hospital/State University of So Paulo/Ribeiro Preto
University Hospital/State University of So Paulo/So Paulo
Helipolis Hospital/So Paulo
Oswaldo Cruz Hospital/So Paulo
Santo Amaro Hospital/Santo Amaro University/So Paulo
Srio Libans Hospital/So Paulo
So Paulo Hospital/Federal University of So Paulo/So Paulo
Arnaldo Vieira de Carvalho Cancer Institute/So Paulo
Pediatric Oncology Institute/Federal University of So Paulo/So Paulo
Vale do Paraba University/So Jos dos Campos (includes the following hospitals: Pio XII Hospital, Municipal Hospital,
Do Vale Oncology Institute, So Jos dos Campos Gastric Clinic, Policrin, Santa Izabel Clinic, and So Jos Hospital).

Braz J Med Biol Res 39(4) 2006

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Epidemiological studies in the information and genomics era

only. Printable copies similar to the computerized forms are available on-line at the
Ribeiro Preto Cell Therapy Center website
(http://ctc.fmrp.usp.br). Following the interview, the data are entered into the system online.
For the centers without the infrastructure
required for processing and storing their own
biological samples (blood), a routine was
organized for the collection and transportation of this material. At a frequency previously agreed upon with each center, blood
samples are collected, packed and transferred to the Laboratory of Medical Investigation-38 of the University Hospital, School
of Medicine of the University of So Paulo.
These samples are then transported weekly
to their final destination at the Ribeiro Preto
Cell Therapy Center. Tumor and normal
tissue samples are also periodically taken to
this Center.

digital page (front-page on-line) and printable formats. Thus, the system has a common language which facilitates communication between the epidemiology and clinical
groups. On the other hand, the code allows
any new researcher that enters the project to
immediately understand the meaning of the
fields in each form.
Evaluation of data quality

The clinical epidemiology team is composed of three epidemiologists. The operational center is located in the Department of
Epidemiology of the School of Public Health,
University of So Paulo, and is staffed by a
statistician, a database management technician, and two support technicians for data
analysis. Two strategies were established:
periodic evaluation of data quality and general evaluation of the consistency of the data
entry performed at each center.

Database and system management

Periodic evaluation of data quality

The different forms are completed at different times during the patients clinical history. The general form is completed upon
the patients entry into the system, at the
time of the interview and the remaining forms
are frequently filled at later times.
Available through the Internet, access to
the CGCP is personalized, using a login
name and a security password defined by the
user. Different degrees of access were established in order to ensure the privacy of patient data. The researchers from a given hospital have unrestricted access to the data of
their own patients, but, in their clinical group,
they can see only the consolidated quantitative data regarding the number of cases and
controls. The researchers from one clinical
group do not have access to any data from
the other groups.
In order to facilitate database use and
understanding, we established code names
that distinguish each field of each form. The
full code is available in the system in both

The clinical epidemiological team issues

periodical reports on the consistency of the
data entered into the general form (cases and
controls) and into the clinical and follow-up
forms (cases). The criteria used for evaluating the data entered into the fields of the
general form are discussed with the clinicians. In the reports, we describe possible
problems in data consistency. For example,
in the general form, confirmation was sought
for all entries regarding the onset of smoking
or alcohol consumption before the age of 10
years.
Data consistency reports for each form
(general, clinical, and follow-up) were sent
to each clinical group between September
2003 and October 2004. When necessary,
alterations in fields for which there were
doubts or which were left blank are carried
out on-line by the centers themselves. The
situation concerning these fields was reevaluated on December 31, 2004.
Braz J Med Biol Res 39(4) 2006

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V. Wnsch-Filho et al.

Evaluation of data entry consistency

In order to evaluate the data entry performed at the centers and to estimate the
magnitude of the possible errors, we examined a random sample of 5% of all patients
included in the system up to February 27,
2004. The selection was stratified by tumor
class and into cases and controls. The final
sample included 66 cases and 46 controls.
The data of the patients selected were
reentered by an external computers skilled
expert specifically contracted for this task
and trained in completing these forms. After
telephone contact, the external expert went
to the clinical center and, based on the paper
copy of the completed forms or on the medical charts of the selected patients, reentered
the data, also on-line. These forms received
different numbers than those used for the
normal entry of patients into the study. Data
reentry took place between April 22, and
May 10, 2004.
We subsequently identified the differences between the original entry by the clini-

Table 1. Number of participants by tumor group and controls recruited from January
2001 to December 2004.
Cases and controls1

Female

Male:female ratio

Total

Cases by tumor group

Astrocytoma
102
Head and neck
547
Esophagus
52
Gastroesophageal junction
24
Stomach
150
Colon and rectum
167
Multiple myeloma
35
Acute lymphoblastic leukemia 112
Osteosarcoma
18
All cases
1207

63
105
10
4
90
161
21
74
14
542

1.6
5.2
5.2
6.0
1.7
1.0
1.7
1.5
1.3
2.2

165
652
62
28
240
328
56
186
32
1749

Controls
Adults (>15 years)
Children (15 years)
Epilepsy2
No information3
All controls

371
220
33
2
626

1.8
0.9
0.9
0.5
1.4

1035
407
64
3
1509

1Excluding
2All

Male

664
187
31
1
883

patients who refused to participate in the study (11 cases and 14 controls).
adults (>15 years). 3Lacking age information.

Braz J Med Biol Res 39(4) 2006

cal group and that by the external expert.

Discrepancies in the data entered into each
field were detected during electronic verification. The comparison was carried out for
the forms fields and for each clinical group.
We also determined whether discrepancies
were due to mistakes made during the data
entry procedures by the clinical group or by
the external expert. Entry mistakes were estimated by dividing the total number of mistakes made by the clinical group by the total
number of the electronic forms fields evaluated. These analyses were processed using
the Statistical Analysis Software (SAS),
version 8.02 for Windows.

Results
From the beginning of 2002 to the end of
December 2004, 1749 cases and 1509 controls were interviewed and entered into the
CGCP database. Eleven cases and 14 potential control patients refused to participate in
the study. Head and neck tumors accounted
for the largest number of cases (652), followed by colon and rectum tumors (328).
With the exception of colon and rectum
tumors, there was a predominance of males
over females. The highest male/female ratios are observed for head and neck, esophagus, and cardia tumors (Table 1).
Tables 2 to 5 present the results of the
evaluation of data entry consistency. In the
general form, considering a total of 3639
fields of the questionnaire examined, the
mean percentage of discrepant information
between the data entry procedures conducted
by the clinical group and that did by the
external expert was 1.7%, ranging from 0 to
4.0% depending on the clinical group (Table
2). In the clinical form, discrepant information ranged from 0 to 6.7% according to the
different clinical groups. The mean proportion of discrepant information in the fields of
the clinical form was only 1.1% (Table 3).
The pathology form showed the lowest proportion of discrepancy, with the highest value

551

Epidemiological studies in the information and genomics era

of 1.0% for the head and neck cancer group

(Table 4). The follow-up form showed the
greatest amplitude in the percentage of discrepancy, which ranged from 0 (zero) for
clinical groups of head and neck, esophagus
and cardia to 11.8% for the leukemia clinical
group (Table 5).

informatics in large-scale studies represents

a break with some of the procedures of traditional health research, but requires adequate
planning and monitoring.
The greatest positive result of the CGCP is
the integration between different clinical
groups in a common project. A single clinical
center would not be able to contribute a suffi-

Discussion
Table 2. Evaluation of data entry consistency in the general form.

The basic characteristics of the CGCP

were established by agreement of the researchers involved. The option for autonomy
of the groups with respect to data collection
and for the use of a computerized structure
for data entry and storage was based on the
consideration that these were the most adequate strategies given the projects circumstances and needs.
For the epidemiology group, which typically functions as a bridge between the clinical and the bioinformatics groups, the greatest challenges were related to the development of alternatives to allow communication between groups, to the determination of
the levels of access of each group to the
computerized system, and to the development of procedures for the evaluation of data
quality aimed at preparing the data for analysis.
Compared to traditional epidemiological
research, the use of the Internet for communication between research groups and for
data entry into a computerized database is
perhaps the most innovative aspect of the
CGCP. A potential disadvantage of the use
of decentralized virtual systems for biomedical data entry is the absence of printed documents for each of the studys patients, kept at
a centralized storage location, as is usual for
clinical and epidemiological studies. After
entry into the system, the CGCP data are
validated, and creating an organized filing
system for keeping printed copies of the
record is not a concern, even though the
patients charts are always a source of information in case of doubts. This use of

Tumors

Astrocytoma
Head and neck
Esophagus
Gastroesophageal junction
Stomach2
Colon and rectum
Multiple myeloma
Osteosarcoma
Leukemia
HC/USP/SP controls3
All

Forms evaluated
Cases

Controls

7
23
2
2
7
13
3
1
7
0
65

4
13
0
0
0
2
2
1
10
13
45

Fields
examined1

301
1455
80
65
245
403
147
60
522
361
3639

Discrepant
information

2
21
0
1
5
6
6
0
8
13
62

(0.7%)
(1.4%)
(0%)
(1.5%)
(2.0%)
(1.5%)
(4.0%)
(0%)
(1.5%)
(3.6%)
(1.7%)

Data are reported as number with percent in parentheses. 1The total number of fields
examined varied among individual subjects. For example, smoking and alcohol consumption information is absent for nonsmokers and nondrinkers. 2 Two questionnaires
selected during sampling but not evaluated (1 case and 1 control). 3At the University
Hospital, School of Medicine, University of So Paulo, controls were recruited from
different inpatient units as a whole group and not separately for each tumor group,
although the same control recruitment procedures as used at the other CGCP centers
were followed.

Table 3. Evaluation of data entry consistency in the clinical form.

Tumors

Astrocytoma
Head and neck
Esophagus
Gastroesophageal junction
Stomach
Colon and rectum
Multiple myeloma
Osteosarcoma
Leukemia2
All

Forms evaluated

7
23
2
2
7
13
3
1
5
63

Fields
examined1
239
1595
350
383
219
751
96
59
179
3871

Discrepant
information
4
8
0
5
0
11
0
1
12
41

(1.7%)
(0.5%)
(0%)
(1.3%)
(0%)
(1.5%)
(0%)
(1.7%)
(6.7%)
(1.1%)

Data are reported as number with percent in parentheses. 1The total number of fields
examined varied among individual subjects. For example, for head and neck cancer,
the field concerning site of the sore was only filled if the patient reported having a sore.
2 Two leukemia patients did not have completed clinical forms.

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V. Wnsch-Filho et al.

cient number of cases of a given tumor to

allow for combined analyses of genetic and
environmental variables and for relevant results to be obtained with respect to etiology
and prognosis. A large number of patients
with different tumors had already been recruited as of December 2004, and another
contingent should be added by the end of
2005.
During the last decades there has been a
Table 4. Evaluation of data entry consistency in the pathology form.
Tumors

Astrocytoma
Head and neck
Esophagus
Gastroesophageal junction
Stomach
Colon and rectum
All

Forms evaluated1

7
22
2
2
7
12
52

Fields
examined2
12
602
46
73
475
571
1777

Discrepant
information
0
6
0
0
0
2
8

(0%)
(1.0%)
(0%)
(0%)
(0%)
(0.4%)
(0.4%)

Data are reported as number with percent in parentheses. 1There are no pathology
forms for multiple myeloma and acute lymphoblastic leukemia. The pathology form
was not completed for one patient of each of the following groups: head and neck
cancer, colorectal cancer, and osteosarcoma. 2 The total number of form fields examined varied among individual subjects. For example, form field concerning the number
of affected lymph nodes in a particular anatomical region was only fulfilled if lymph
nodes had previously been indicated in that region.

Table 5. Evaluation of data entry consistency in the follow-up form.

Tumors

Astrocytoma
Head and neck
Esophagus
Gastroesophageal junction
Stomach
Multiple myeloma3
Leukemia
All

Forms evaluated1

Fields
examined2

7
15
1
1
10
1
5
40

141
79
49
6
131
271
677

Discrepant
information
1
0
0
0
3
32
36

(0.7%)
(0%)
(0%)
(0%)
(2.3%)
(11.8%)
(5.3%)

Data are reported as number with percent in parentheses. 1Number of patients per
group without a completed follow-up form: head and neck - 8; esophagus - 1; cardia 2; gastric - 6; colorectal - 3; multiple myeloma - 2; osteosarcoma - 1; leukemia - 2. 2 The
total number of fields examined varied among individual subjects. For example, for
patients with astrocytoma, only fields related to treatment were completed if the patient
had undergone chemotherapy or radiotherapy. 3 The only patient selected was not
evaluated. In this group the researchers did not open new follow-up forms each time
the patient returned, but, instead, information on clinical alterations was repeatedly
altered in the same form.

Braz J Med Biol Res 39(4) 2006

significant evolution in epidemiological methods, especially with respect to statistical analysis. Epidemiologists today are able to operate
with mathematical models; however, mastering these technologies does not solve essential
problems related to the quality of research data
and the magnitude of the biases that cannot be
controlled during analysis, two key elements
if one wishes to establish accurate cause and
effect inferences. The mean percentage of
entry errors among the CGCP clinical groups
was only 1.7%, which indicates the reliability
of the data included in the database via the
Internet. Furthermore, the continuous monitoring of data will further ensure their quality.
We have properly identified the biological
samples from essentially all patients and, according to preliminary analyses carried out at
the Ribeiro Preto Cell Therapy Center, this
material is very satisfactory. The quality of the
diagnoses is also ensured, as indicated by the
analysis of the pathology forms.
Large-scale projects are multidisciplinary
and, in order to be effective, depend on a good
informatics infrastructure. As it consolidates
an expressive number of cases of different
neoplasms, the CGCP in fact involves four
large projects involving tumors at specific
anatomical sites such as neurological, head
and neck, and digestive system tumors, and
the pathology group, and also into two smaller
projects of multiple myeloma and osteosarcoma, each of which includes only a single
clinical center. These projects are aimed at
testing specific hypotheses regarding the etiology and prognosis of these diseases and
have become feasible thanks to the availability of reliable and comprehensive patient data,
as well as of a biological material bank well
integrated to the clinical data.
Genomics is expanding the horizons of
epidemiology, providing a new dimension
to classical case-control, cohort, and crosssectional studies, and is estimulating the development of large-scale multicenter studies
aimed at discovering and characterizing
genes related to common diseases (8). How-

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Epidemiological studies in the information and genomics era

ever, the principle remains that the transformation of data into information useful for
clinical application and for the planning of
preventive measures depends essentially on
the quality of these data. Thus, study design

and the implementation of a strategy based

on large-scale multicenter studies for cancer
research using the Internet require an objective scrutiny of the data so that valid results
can be obtained in the analysis.

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List of CGCP participants

Coordinator: Marco Antonio Zago.
Astrocytoma group:
Alberto Alain Gabbai, Carlos Gilberto Carlotti Jnior, Suely Kazue Nagahashi Marie, Suzana Malheiros, Benedicto O. Colli, Sueli Oba.
Multiple Myeloma group:
Gisele Colleoni, Jos Orlando Bordin, Jos Salvador R. De Oliveira, Maria de Lourdes L.F. Chauffaille, Maria Regina Regis Silva,
Maria Stella Figueiredo, Mihoko Yamamoto, Yuri V. Pinheiro.
Osteosarcoma group:
Antonio Sergio Petrilli, Slvia Regina Caminada de Toledo.
Acute Lymphoblastic Leukemia group:
Antnio Srgio Petrilli, Carlos Gilberto Carlotti Junior, Luiz Gonzaga Tone, Maria Lcia de Martino Lee, Silvia Regina Brandalise,
Vicente Odone Filho, Vitria Rgia Pereira Pinheiro.
Esophageal and Gastroesophageal Junction Cancer group:
Ivan Cecconello, Jos Carlos del Grande, Danilo Gagliardi, Maria Aparecida Arruda Henry, Marcelo Augusto de Oliveira, Orlando Contrucci.
Stomach Cancer group:
Joaquim Gama-Rodrigues, Larcio Loureno, Srgio Leonardi, Nelson Andreollo, Reginaldo Ceneviva, Fabio Lopasso, Jos Eduardo Krieger,
Kiyoshi Iriya, Marcelo Eidi Nita, Osmar Yagi, Ulysses Ribeiro Jr., Jos Carlos Del Grande, Cludio Bresciani, Carlos Eduardo Jacob,
Carlos Malheiros, Fares Rahal, Shoiti Kobayasi, Nadin Safatle, Paulo Kassab.
Colon and Rectum Cancer group:
Angelita Habr-Gama, Dlcio Matos, Nora Manoukian Forones, Raul Cutait, Jos Eduardo Krieger, Bernardo Garicochea.
Head and Neck Cancer group:
Francisco Gorgonio da Nbrega, Jos Francisco de Gis Filho, Marcos Brasilino de Carvalho, Pedro Michaluart Junior, Vera Capelozzi,
Patrcia M. Cury, Erica Erina Fukayama, Marina Pasetto Nbrega, Carlos Frederico D. Pinto, Arthur C. Pereira da Silva, Abaet Leite do Canto,
Joo Moreira dos Santos, Paulo Vitor F. Souza Nascimento, Carlos Flavio Turci, Adriano Batista Diniz Mendes, Carlos de Oliveira Lopes.
Pathologists group:
Kioshi Iriya, Marcelo Fabiano de Franco, Patrcia M. Cury, Sergio Rosenberg, Venncio Avancini Ferreira Alves, Vera Luiza Capelozzi.
Clinical Epidemiologists group:
Jos Eluf Neto, Paulo Andrade Lotufo, Victor Wnsch Filho.

Braz J Med Biol Res 39(4) 2006